Immunologic diagnosis of schistosomiasis: III. The effects of nutritional status and infection intensity on intradermal test results in St. Lucian children

David A. McKayDepartments of Medicine and Community Health (formerly Preventive Medicine), Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, and the Research and Control Department, Castries, St. Lucia, West Indies

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Kenneth S. WarrenDepartments of Medicine and Community Health (formerly Preventive Medicine), Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, and the Research and Control Department, Castries, St. Lucia, West Indies

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Joseph A. CookDepartments of Medicine and Community Health (formerly Preventive Medicine), Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, and the Research and Control Department, Castries, St. Lucia, West Indies

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Peter JordanDepartments of Medicine and Community Health (formerly Preventive Medicine), Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, and the Research and Control Department, Castries, St. Lucia, West Indies

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The question of the insensitivity of immediate and delayed skin testing in children was studied with respect to both nutritional status and intensity of infection. Ninety-seven children on the island of St. Lucia, 5 to 11 years of age, with almost equal male: female distribution, all excreting eggs of Schistosoma mansoni were tested as follows: qualitative and quantitative stool examinations; anthropometric measurements (height, weight, mid-arm circumference and triceps skinfold thickness); hematocrit; fluorescent antibody test; and skin tests with control material, S. mansoni adult worm antigen (both Puerto Rican and St. Lucian strains), and intermediate strength PPD tuberculin. The anthropometric measurements revealed marginal malnutrition among the children. The overall positive intradermal response rate for each of the two antigens was similar, being 56% for the immediate and 37% for the delayed test. There was no relationship discernible between relative over- and under-nutrition and the skin test responses. A striking and highly significant positive association was revealed, however, between the intensity of infection, as shown by quantitative egg counts, and the sensitivity and extent of both the immediate and delayed skin test reactions.

Author Notes

Carnegie-Commonwealth Clinical Scholar, CWRU; present address: Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27514.

Staff member, The Rockefeller Foundation.

External Staff, Medical Research Council, seconded to The Rockefeller Foundation.

Address reprint requests to: Dr. Kenneth S. Warren, Department of Community Health, Wearn Research Building, University Hospitals, Cleveland, Ohio 44106.
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